A chief advocate for the "medical home" concept says the support of leading health plans has put Michigan ahead of the game in adopting a business model that's transforming the way medicine is practiced in America.

A patient-centered medical home has physicians taking a more proactive role in caring for patients and serving as coordinators of care.

Patient interaction also comes in different forms. Under the model, for example, care providers are reimbursed for using e-mail and telephone to consult with patients, such as delivering the results of an annual cholesterol blood test, rather than doing it through an office visit.

Financially, the model pays physicians to spend more time with patients, versus the traditional method of reimbursing based on procedure, to keep them healthy or to better manage a chronic condition.

The result could generate large savings for a health system and drive better quality.

Their support is key for medical practices that want to make the transition to a business model that's viewed as a much more cost-effective way to deliver care, said Paul Grundy, the director of health care transformation at IBM Corp. He gave a trio of presentations in mid-September in Grand Rapids on the medical-home movement.

"They've been very engaged," Grundy said. "In Michigan, there's a tremendous amount of interest and activity on this.

"You're (more) ahead of the game than most parts of the country."

Grundy also chairs the Patient-Centered Primary Care Collaborative, a consortium of several large national employers founded in 2006 to create a better delivery model.
His presentations last week offered frustration from an employer's perspective with a message of hope about the medical home and its potential to improve quality and control costs.

He cites a study by Geisinger Health System in Pennsylvania, which was able to cut medical costs by 7 percent using a medical-home model for some 80,000 patients visits.

"It's going to become increasingly more available in the next five years," Grundy said.
Key to the adoption of the model are health plans, Grundy said.

About $30 million of the $50 million Blue Cross Blue Shield of Michigan planned to spend this year on its Physician Group Incentive Program is going to physicians who incorporate the patient-centered medical-home model into their practices.

Blue Cross Blue Shield is working with more than 5,000 doctors across the country who are using or implementing the model in a pilot that involves 1.2 million patients, President and CEO Dan Loepp said. The insurer will then provide participating doctors higher reimbursements.

"By bringing patients and medical professionals together, we are promoting opportunity for better care by the primary-care physician, leading to better overall outcomes," Loepp said during an address at the West Michigan Regional Policy Conference.

Priority Health is directing more than $500,000 toward a similar pilot aimed at physician groups using the patient-centered medical-home model.

While doctors, insurers and employers that buy health care generally agree on the concept's benefits, the medical home's biggest obstacle is perhaps in relative lack of major deployment nationally, Grundy said.

Employers nationally that want to contract with a health plan that supports the medical-home model are finding limited offerings for now, he said.

Medical practices, he said, typically take two years or more to fully transition to a medical-home model.

"It isn't a model that's on the shelf. We have to build it," Grundy said. "It's a real change in the way you practice medicine. It requires a whole different attitude and set of skills."